Please complete the below form with as much detail as possible to help us assist you. If you would prefer to talk directly to one of our Member Services representatives call 0800 892 150 or 990 from your Black + White mobile.

First Name:
Last Name:
Black + White Mobile Phone Number:
Email Address:
Security Pin (4 digits):
Do you wish to:	Cancel in 30 daysCancel immediately ($100 charge applies)
If you wish to specify a date after 30 days from now to cancel your account, please enter here:
Why are you leaving?
Who do you plan to move to?	TelecomTelstraClearVodafone2 DegreesOtherNone- Disconnection
Is there anything we can do to make you stay?
Are you porting your number? [ This means transfering the number to another mobile provider. ]	YesNo

By submitting this form you must note:

1. You are requesting to cancel your account in 30 calendar days free of charge or on the next business at a fee of $100. On this day you will no longer be covered by our network or services.
2. If you are porting/transferring your number to another provider we will not cancel your service until we receive a valid port request from your new provider, you will be liable for all charges until we receive a port request from your new provider. Note if this request is received before 30 days we will accept the request but the Express Termination Fee will be payable.
3. If you change your mind you must let us know otherwise we will continue to proceed in line with the information provided in this form.

For terms and conditions click here.